First patient complaint ever. Frustrated.

I had a pt's daughter come to the ED telling me she had given her father his third nitro and he was still having chest pain. I asked her where her father was and she said in the lobby. I had no patients pending so asked for his name. She gave it. I went looking for the chart. I tracked it down to walk-in clinic. The complaint for walk in was cough, runny, nose and chest pain with cough. I went to my charge and asked what he thought we should do since the daughter was so insistent. He told me to go to talk to the walk-in doc. Could not get a hold her talked to her nurse. Her nurse said if he was taking nitro he should go to the E.D. (I already thought this myself but was trying not to step on senior nurses toes).

I was going out to reassess the patient when I ran into the triage nurse. I asked her why she thought this was appropriate for walk-in. This nurse is awesome so it would surprise me that she would triage someone like this to walk-in if in fact he was having chest pain indicated of heart attack. She told that the patient came in by himself and basically complained of cold symptoms he did give a history of a heart attack 3 months ago but that he said this did not feel like that at all. He did not take the nitro when he was triaged.

I pulled the patient into triage. I know that this patient is fluent in English because I have treated him before but the daughter refused to let him speak English. She was doing all the talking and explained why she thought this was his diagnosis. I told her I needed for him to tell what was wrong with him since I was recieving so many conflicting stories. I asked for a medical interpreter so that I could get the complaint straight from the patient. He ended telling us runny nose, cough, and epigastric pain.

The daughter started screaming at me and telling me she was nurse and that I was a racist. It was so frustrating. I could care less about her. I need to know what is wrong with the patient. She is not a nurse by the way. She apparently has come into our facility several times and raised hell when her family was not seen in immediately through the E.D. for things that could wait for an appt or could go through our walk-in clinic. But it's not the point. I feel like I got caught in this woman's frustrations with her own inability to become a nurse. Allegedly she had worked at our facility sometime ago as an NA but could not pass the first semester of nursing school. I know that she was scared for her father but she can't just go around lying about people's symptoms so that they get through faster.

So anyway, the charge nurse that told me to reassess the patient and to get the complaint from the patient. Backed the daughter up when he saw that she was writing people up. The EKG, the labs, the echo, the x-ray, the u/s. All came back normal but because this lady wrote me up...the doctor elected to send the patient on 50,000 flight to a higher level of care. His only abnormal lab was a alk phos of 146?!

Now, I am afraid I will be expected to write an apology. I am so ****** because I first tried to help this lady and her father to ensure he got the appropriate care. Second, my charge instructed me to follow these procedures even though for customer service reasons I knew it would be easier just to pull the guy back do the work-up and send his ass home. Instead, we spent all this money that could have been used on other patients who might need elective surgeries and the such to make this woman feel better about her assessment skills.

Grrrrr. I feel even worse that the meditation and relaxation techniques I have been working on and trying to let things at work bother me is not effective.

Any suggestions from people? It's okay if you tell me I was a jerk. But that guy would have still been sitting in the lobby if it had not been for me trying to give good customer service.

You can't help the crazies. It will not be your last patient complaint even if you are the best Nurse in the world. Remember that people are people with all the quirks that come with it.

Aug 20, '09

Sometimes you can do no right and it sucks and is totally unfair and it is really sad that those with the powerallow this to happen and encourage by not backing their staff.

If you are in the wrong, then fine, but she was clearly manipulating the system and you got stuck in the miss.

You have my complete and total sympathy!

Aug 20, '09

It is never wrong to do the right thing for the patient. In this case, you wanting to get a correct subjective assessment was the right thing to do. Your superiors should know this is necessary in order to appropriately triage and assign him. There will always be those who will manipulate the system- all we can do is the best we can do. Follow policies, protocols, and standards of care and you will (for the most part) be ok. Good luck.

Last edit by cookienay on Aug 20, '09
: Reason: clarity

Aug 20, '09

You'll never please all of the people all of the time. Learn from it and move on. As above, this certainly won't be your first (or last) complaint. Just take it as constructive criticism.

Aug 20, '09

I have found when someone uses the 'I'm a nurse' line when giving their medical tale (or family member's) tends to translate that I work as a CNA or I have watched several episodes of Trauma Life in the ER and thought about going to nursing school. Most of these people I have found to be a tad less than rational.

Aug 20, '09

Be sure to write things down exactly as they happened using the pts MR# and DOB as soon as possible. That way if there is a complaint, you have documented everything while they are fresh in your memory. I have even gone as far as writing down what happened, copying the chart and then giving it to the NM/DON so that they have a heads up to the possible complaint. They appreciate getting the heads up so that they know the whole story as soon as the complaint is made.

There are always going to be unreasonable patients and family members. You can only do the best you can do. Let the boss deal with the unreasonable complaints. Good luck.

I had a pt's daughter come to the ED telling me she had given her father his third nitro and he was still having chest pain. I asked her where her father was and she said in the lobby. I had no patients pending so asked for his name. She gave it. I went looking for the chart. I tracked it down to walk-in clinic. The complaint for walk in was cough, runny, nose and chest pain with cough. I went to my charge and asked what he thought we should do since the daughter was so insistent. He told me to go to talk to the walk-in doc. Could not get a hold her talked to her nurse. Her nurse said if he was taking nitro he should go to the E.D. (I already thought this myself but was trying not to step on senior nurses toes).

I was going out to reassess the patient when I ran into the triage nurse. I asked her why she thought this was appropriate for walk-in. This nurse is awesome so it would surprise me that she would triage someone like this to walk-in if in fact he was having chest pain indicated of heart attack. She told that the patient came in by himself and basically complained of cold symptoms he did give a history of a heart attack 3 months ago but that he said this did not feel like that at all. He did not take the nitro when he was triaged.

I pulled the patient into triage. I know that this patient is fluent in English because I have treated him before but the daughter refused to let him speak English. She was doing all the talking and explained why she thought this was his diagnosis. I told her I needed for him to tell what was wrong with him since I was recieving so many conflicting stories. I asked for a medical interpreter so that I could get the complaint straight from the patient. He ended telling us runny nose, cough, and epigastric pain.

The daughter started screaming at me and telling me she was nurse and that I was a racist. It was so frustrating. I could care less about her. I need to know what is wrong with the patient. She is not a nurse by the way. She apparently has come into our facility several times and raised hell when her family was not seen in immediately through the E.D. for things that could wait for an appt or could go through our walk-in clinic. But it's not the point. I feel like I got caught in this woman's frustrations with her own inability to become a nurse. Allegedly she had worked at our facility sometime ago as an NA but could not pass the first semester of nursing school. I know that she was scared for her father but she can't just go around lying about people's symptoms so that they get through faster.

So anyway, the charge nurse that told me to reassess the patient and to get the complaint from the patient. Backed the daughter up when he saw that she was writing people up. The EKG, the labs, the echo, the x-ray, the u/s. All came back normal but because this lady wrote me up...the doctor elected to send the patient on 50,000 flight to a higher level of care. His only abnormal lab was a alk phos of 146?!

Now, I am afraid I will be expected to write an apology. I am so ****** because I first tried to help this lady and her father to ensure he got the appropriate care. Second, my charge instructed me to follow these procedures even though for customer service reasons I knew it would be easier just to pull the guy back do the work-up and send his ass home. Instead, we spent all this money that could have been used on other patients who might need elective surgeries and the such to make this woman feel better about her assessment skills.

Grrrrr. I feel even worse that the meditation and relaxation techniques I have been working on and trying to let things at work bother me is not effective.

Any suggestions from people? It's okay if you tell me I was a jerk. But that guy would have still been sitting in the lobby if it had not been for me trying to give good customer service.

We cant' sit here and second guess everything that was happening cause we don't have all the details.
I'm not really sure what your question is...?

If you are asking about the triage process here's my take:
1) Regardless of where the pt signed into, doesn't mean they need to go there. Each pt is assessed by nursing based on their own merits. So he may have started out as a "walk-in" but could have been upgraded to main ER to treat
2) One of the MOST COMMON lawsuits is missed cardiac complications so ALWAYS err on the side of caution. If your ER MD doesn't like this then tough crap; just remind them why THEY practice defensive medicine!
3) I'm thinking cardiac workup for the following:
-non traumatic cp
-nearly ANY cardiac hx (esp recent surgery)
-age > 40/45
-personal/family Hx of cardiac
-other medical conditions (DIABETES = red flag!)

DO NOT let the useful ness of NTG fool you! Sometimes it may point to cardiac, other times not; EVEN when it works sometimes!
DO NOT let the duration of symptoms fool you - CP for '2 weeks' can still be coronary/anginal equivalents; are they having an ACUTE MI right now? Probably not. But do they need to be placed in a MONITORED room and a cardiac assesment done ABSOLUTELY!!!

Keep your chin up, remember you did right by the patient and that's the primary purpose!
-MB

Aug 21, '09

Certainly it is frustrating being written up by a patient and/or family member especially when you really put alot of effort into finding the patient, trying to get the right story, trying to triage hime approp., etc.

Look at it this way. Writing you up was just another tool in this daughter's arsenal of manipulative tactics. Trying to manipulate the system, trying to make you nervous, get her father seen faster. It is very annoying. However, I think you did just fine. At my work place, even if a family member speaks the native language, we cannot rely on them to tell us the story. We have to get an interpreter or use our interpreter phone to triage the patient. I suppose most ED's do this?

And what did she actually write you up for? Just curious.

Jeanne

Aug 26, '09

Sounds like she was going to write someone up before she ever got to you- she just needed to find out your names.

My comment is that if you have a patient with CP taking nitro they need to be triaged and sent into the main ER, and time spent looking for records is costing them heart muscle. Pull them into the booth, triage them, then call whoever needs to know and let them know the patient presented to you, and you did x, y, z, and the patient is now in the main ER (if that's what they need), or that you sent them back whence they came and will forward the paperwork.

I would also triage based on daughter's statements, and then say you must hear from the man himself, and go through it with the interpreter. She may be makig the complaint because she felt ignored, and the fastest way to HIS story is sometimes to let the relative have their say and then turn to the patient and ask them to give you the whole thing again from their perspective.

Sep 3, '09

i thought with chest pain you do a stat EKG - a lot of time was spent before the EKG -- at least the reading would give you some ammo against the disgruntled family member.

You didnt do anything wrong, and as others have mentioned you cant please everyone.
Im a 2nd year student nurse, and I have so much love and respect for most ER nurses. You take verbal abuse, physical abuse, lucky to get a pat on the back from administration ..and yet you show up to work everyday ready to do it again! gotta love it

Sep 4, '09

Sounds like you did nothing wrong.
I have worked with some great nurses and doctors that have gotten totally bogus complaints from disgruntled patients and/or family members.
We see so many people every day, it is impossible to please every person (especially the crazy ones) all the time. You will get patient complaints every now and then, no matter how good a nurse you are.
All you can do is reassure yourself that you did everything correctly and to the best of your ability at the time and move on.

We cant' sit here and second guess everything that was happening cause we don't have all the details.
I'm not really sure what your question is...?

If you are asking about the triage process here's my take:
1) Regardless of where the pt signed into, doesn't mean they need to go there. Each pt is assessed by nursing based on their own merits. So he may have started out as a "walk-in" but could have been upgraded to main ER to treat
2) One of the MOST COMMON lawsuits is missed cardiac complications so ALWAYS err on the side of caution. If your ER MD doesn't like this then tough crap; just remind them why THEY practice defensive medicine!
3) I'm thinking cardiac workup for the following:
-non traumatic cp
-nearly ANY cardiac hx (esp recent surgery)
-age > 40/45
-personal/family Hx of cardiac
-other medical conditions (DIABETES = red flag!)

DO NOT let the useful ness of NTG fool you! Sometimes it may point to cardiac, other times not; EVEN when it works sometimes!
DO NOT let the duration of symptoms fool you - CP for '2 weeks' can still be coronary/anginal equivalents; are they having an ACUTE MI right now? Probably not. But do they need to be placed in a MONITORED room and a cardiac assesment done ABSOLUTELY!!!

Keep your chin up, remember you did right by the patient and that's the primary purpose!
-MB

Yeah, but why should her boss dump her like that? Why should she suffer for being a good nurse trying to help the patient? Why are bosses such troublemakers sometimes? Why don't they back up their staff who are doing good work? Why is the moon made of green cheese?